What is PSA Screening?

Since 1994, male patients over the age of 50 years received a PSA test as part of a routine physical exam, even for those who do not experience symptoms of prostate cancer.

In the spring of 2012, an independent board of health experts known as the U.S. Preventative Services Task Force recommended against this routine screening, worrying the PSA provides too many suspicious or incorrect results resulting in unnecessary and potentially harmful biopsies and treatments.

This announcement shook the medical community and confused many American males who thought they understood the principles of PSA screening. Doctors and patients are now reviewing what they know about prostate screening, and are deciding that PSA screening still gives men the edge against this serious disease.

Aside from one type of skin cancer, prostate cancer is the most common cancer among American men, and it is one of the leading causes of death among men of all races. According to the Centers for Disease Control and Prevention, or CDC, doctors diagnosed 206,640 men with prostate cancer in 2009. The PSA test, prompt action, and quality medical care reduce these risks.

A PSA laboratory test looks for prostate cancer in men. This test also helps a doctor determine whether the patient needs a biopsy of his prostate, monitors the effectiveness of prostate cancer treatment, and screens for the return of prostate cancer after treatment.

Since 1994, male patients over the age of 50 years received a PSA test as part of a routine physical exam, even for those who do not experience symptoms of prostate cancer.

The PSA screen measures the levels of prostate specific antigen, a protein manufactured exclusively in the prostate gland. The higher the levels of PSA, the likelier it is the patient has cancer. Medical laboratories report PSA levels in terms of nanograms of PSA per milliliter of blood, or ng/mL.

There is little confusion about dealing with very low or very high PSA levels – low levels require no action while very high levels require immediate, aggressive action. Most doctors consider a normal PSA test result to be less than 4.0 ng/mL, although some doctors want this normal value dropped to 2.5 ng/mL to catch prostate cancer earlier. PSA levels greater than 10 ng/mL strongly indicate the presence of prostate cancer. Doctors normally swing into aggressive action when PSA reports come back this high.

PSA levels between 4 ng/mL and 10 ng/mL are considered the “gray zone,” where test results do not definitively say whether the patient has cancer or not. Further screening, including specialized PSA blood tests, prostate exam, urine tests, ultrasounds, x-rays, and biopsies, can determine this patient’s risk for prostate cancer.

Higher levels of PSA are associated with an increased risk for cancer but other things can raise PSA levels too. Some men with prostate cancer do not have high PSA levels.

Health experts agree that PSA tests are not perfect, but many feel strongly that PSA tests save thousands of lives each year. PSA tests are easy, inexpensive, relatively painless and can reduce the risk for prostate cancer in all men.